Individual
TRISHA ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
222 SAINT JOHN ST STE 130, PORTLAND, ME 04102-3055
(207) 651-3428
Mailing address
43 LAWRENCE ST, WESTBROOK, ME 04092-4251
(207) 651-3428
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC12055
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432143199
—
ME
Enumeration date
03/02/2007
Last updated
12/08/2010
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